Waiting for ICU admission may increase the risk of death—A plea for better resource organization

Abstract

Overall hospital mortality of critically ill patients has been reported to range from 13.5% to 31%, and it has been the subject of extensive research in order to understand which patients are at a higher risk of dying. 1,2 The survival curve related to Intensive Care Unit (ICU) admission is known to be determined in the short term by characteristics of the acute illness and the related residual organ dysfunction and by individual characteristics, like age and comorbidities in the long term. 3,4 Multiple other determinants of post-ICU early mortality have been described which are related to the resource capacity of the hospital and how those resources are organized. The low number of intensive care beds per inhabitant, 5,8 the absence of intermediate care units 9 and in-hospital emergency teams, the pressure to vacate beds and to discharge patients during night shifts, 10 and the scarcity of nurse staff on the wards 3 have all been shown to have a negative impact on survival of critically ill patients.Whether individual or organizational, those factors need to be recognized and addressed early as this may help guiding treatment planning and direct interventions towards better resource organization, and ultimately lead to better short-and long-term outcomes. | OBJEC TIVE STo understand risk factors for ICU and hospital mortality and their association with resource organization. | ME THODSWe conducted an observational retrospective study at the general ICU of Faro Hospital, Algarve, Portugal. Faro Hospital is a 650-acute bed hospital with a 14-bed general ICU, 1 intermediate care unit with 10

Association between the timing of ICU admission and mortality in patients with hospital-onset sepsis: a nationwide prospective cohort study

“…While some studies have demonstrated an association between mortality and delays in ICU admission, [ 24 , 25 ] others have reported contradictory results. For example, a prospective cohort study of 1675 patients admitted to the ICU showed that the length of ED stay was not associated with hospital mortality ( P = 0.82) [ 11 ].…”

The COVID-19 pandemic: a gateway between one world and the next!

“…Furthermore, even if intubation is deemed necessary and timely accomplished, a prolonged stay in the ED with delayed ICU admission is another issue. Undeniably, delayed ICU admission has shown a significant impact on critically ill patients [15] , [16] , and there are no reasons why this should impact differently in specific disease as COVID-19. Certainly, a mechanically ventilated patient remaining for several hours in the ED because of absence of ICU beds will not receive the specialized treatment that can be fully delivered only in the ICU.…”